COVID-19 Supplements: Yet Another Study Advocates Vitamin C As An Adjuvant To Treat COVID-19
: A new study by researchers from the Institute for Optimum Nutrition-UK, University of Otago-New Zealand, Swansea University Medical School-UK, Morriston Hospital-UK Eastern, Virginia Medical School-USA and University of Oxford-UK demonstrates that Vitamin C can be used as an adjuvant to treat COVID-19 especially in the severe and critical stages.
Ascorbic acid or vitamin C appears to favorably modulate host responses to SARS-CoV-2, the causal agent of COVID-19 disease according to the study team.
The study focuses on vitamin C deficiency in respiratory infections including COVID-19; the mechanism of action in infectious disease and adrenal function supporting the anti-inflammatory actions of glucocorticosteroids: its role in preventing and treating colds and pneumonia and its role in treating sepsis and COVID-19.
The study findings indicate that oral vitamin C (2-8g/d) may reduce incidence and duration of respiratory infections and intravenous vitamin C (2-24g/d) has been shown to reduce mortality, Intensive Care Unit and hospital stays, time on mechanical ventilation in severe respiratory infections.
Considering the favourable safety profile and low cost of vitamin C, and frequency of vitamin C deficiency in respiratory infections it may be worthwhile testing patients’ vitamin C status and treating accordingly with intravenous use within ICUs and orally with doses between 2 and 8g/day in hospitalized and infected persons.
The study findings were published on a preprint server but are currently being peer reviewed. https://www.preprints.org/manuscript/202010.0407/v1
The U.S. NIH also advocates using Vitamin C in COVID-19 treatments. https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/vitamin-c/
There were also previous studies that also advocated Vitamin C as an adjuvant for COVID-19 treatments and even as a prophylaxis.
The supplement Vitamin C, also known as ascorbic acid, is an essential water-soluble nutrient. Humans depend on vitamin C from the nutritional supply by fruits and vegetables (red peppers, oranges, strawberries, broccoli, mangoes, lemons). The potential role of vitamin C in preventing and ameliorating infection is well established in medical science.
Vitamin C is crucial for immune responses. It h
as important anti-inflammatory, immunomodulating, antioxidant, antithrombotic, and antiviral properties. https://jtd.amegroups.com/article/view/34870/html
The study demonstrates the potential role of vitamin C in preventing the critical phase of COVID-19, acute respiratory infections, and other inflammatory diseases. Vitamin C supplementation could hold promise as a preventive or therapeutic agent for COVID-19 - to correct a disease-induced deficiency, reduce oxidative stress, enhance interferon production, and support the anti-inflammatory actions of glucocorticosteroids.
In order to maintain a normal plasma level of 50 µmol/l in adults, a vitamin C dose of 90 mg/d for men and 80 mg/d for women is required. This is enough to prevent scurvy (a disease resulting from a lack of vitamin C). However, this level is inadequate for preventing viral exposure and physiological stress.
Importantly, the Swiss Society of Nutrition recommends a supplement of 200mg of vitamin C for everyone - ‘to fill the nutrient gap for the general population and especially for the adults aged 65 and older. This supplement is targeted to strengthen the immune system.’ https://www.sge-ssn.ch/media/Nutritional-status-in-supporting-a-well-functioning-immune-system-for-optimal-health-with-a-recommendation-for-Switzerland-1.pdf
It has been found that a rapid decline in the human serum vitamin C levels is observed under conditions of physiological stress. A serum level of vitamin C ≤11 µmol/l is found in hospitalized patients the majority of them suffering from acute respiratory infections, sepsis, or severe COVID-19.
Various case studies reported from across the world demonstrate that low vitamin C levels are typical in critically-ill hospitalized patients, with both respiratory infections, pneumonia, sepsis, and COVID-19 the most likely explanation being increased metabolic consumption.
Interestingly a detailed meta-analysis highlights these observations:
-the risk of pneumonia is significantly reduced with vitamin C supplementation, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099400/
-post-mortem investigations in COVID-19 deaths show a secondary pneumonia phenomenon
-total pneumonia cohorts comprised 62% with hypovitaminosis C.
Significantly vitamin C has an important homeostatic role as an antioxidant. It is known to demonstrate direct virucidal activity and augment interferon production. It has effector mechanisms in both the innate and adaptive immune systems. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1541262/
Furthermore vitamin C lessens reactive oxidative species (ROS) and inflammation via attenuation of NF-κB activation. https://pubmed.ncbi.nlm.nih.gov/25253919/
It should also be noted that while SARS-CoV-2 downregulates the expression of type-1 interferons (the host's primary antiviral defense mechanism), ascorbic acid upregulates these key host defense proteins. https://pubmed.ncbi.nlm.nih.gov/31852327/
Often, the critical and fatal phase of COVID-19 occurs with the excessive generation of potent proinflammatory cytokines and chemokines. This results in the development of multi-organ failure. It is associated with neutrophil migration and accumulation within the lung interstitium and bronchioalveolar space ie a key determinant of ARDS (Acute respiratory distress syndrome). https://pubmed.ncbi.nlm.nih.gov/23036432/
It has been known that ascorbic acid concentrations are three to ten times higher in the adrenal glands and pituitary than in any other organ. Under conditions of physiological stress (ACTH stimulation), including viral exposure, vitamin C is released from the adrenal cortex resulting in a fivefold increase in plasma levels. https://onlinelibrary.wiley.com/doi/full/10.1111/odi.12446
Hence vitamin C enhances cortisol production and potentiates the anti-inflammatory and endothelial cytoprotective effects of glucocorticoids. https://pubmed.ncbi.nlm.nih.gov/7772741/ https://pubmed.ncbi.nlm.nih.gov/28739448/
Importantly exogenous glucocorticoid steroids are the only proven treatment for COVID-19. Vitamin C, a pleiotropic stress hormone, plays a critical role in mediating the adrenocortical stress response, particularly in sepsis, and protecting the endothelium from oxidant injury. https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
Common colds or flus are caused by over 100 different virus strains, some of which are coronaviruses.
Considering the effect of vitamin C on colds ie reduced duration, severity, and the number of colds, vitamin C administration may reduce conversion from mild infection to the critical phase of COVID-19. https://www.semanticscholar.org/paper/Moolla-ME.-The-effect-of-supplemental-anti-oxidants-Town-Moolla/13ab0af53d75eb7ae194c5581229662134ebfe4d
Also vitamin C supplementation is observed to reduce the length of ICU stay, shorten the ventilation time in critical COVID-19 patients, and reduce sepsis patients' mortality requiring vasopressor treatment.
The study also indicates the safety of oral and intravenous administration of vitamin C, considering the various scenarios of diarrhea, kidney stones, and kidney failure during high dosages. A safe, short-term high dose of 2-8 g/day may be recommended (cautiously avoiding those with a history of kidney stones or kidney disease from high doses). Being water-soluble and thus excreted within hours, dose frequency is important to maintain sufficient blood levels during active infection.
The supplement Vitamin C is known to prevent infections and improve immune responses. With specific reference to the critical phase of COVID- 19, vitamin C plays a critical role. It downregulates the cytokine storm, protects the endothelium from oxidant injury, has an essential role in tissue repair, and improves immune responses against infections.
Ascorbic acid also shows promising results when administered to the critically ill.
The researchers recommend that individuals in high-risk groups for COVID-19 mortality and at risk of vitamin C deficiency should be encouraged with vitamin C supplementation daily. They should ensure vitamin C adequacy at all times and increase the dose when virally infected to up to 6-8 g/day.
Currently several dose-dependent vitamin C cohort studies are underway across the world to confirm its role in mitigating COVID-19 and better understand its role as therapeutic potential.
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